Kryptokokkenmeningoenzephalitis bei einem HIV-positiven Patienten mit Rezidiv bei Resistenz gegenüber Fluconazol und IRIS

Seilmaier, Michael; Hecht, Anna; Guggemos, Wolfgang; Rüdisser, Klaus

doi:10.1007/s00063-009-1007-9

Cited by 2 publications

(2 citation statements)

References 19 publications

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“…In order to obtain an accurate diagnosis, microbiology culture is the gold standard [5,32-35]. Imaging and fluconazole resistance testing in patients with recurrent meningitis may also be used in guiding treatment decisions [34,36-39].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Management of Cryptococcal Relapse

et al. 2013

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Despite improvements in the antifungal regimens and the roll out of antiretroviral therapy (ART) in sub-Saharan Africa, mortality due to cryptococcal meningitis remains high. Relapse of an initially successfully treated infection contributes to this mortality and is often a clinical dilemma in differentiating between paradoxical immune reconstitution inflammatory syndrome (IRIS) and culture-positive relapse or treatment failure. Herein, we present a clinical case scenario and review the case definitions, differential diagnosis, and management of relapse with an emphasis on the current diagnostic and management strategies. We also highlight the challenges of resistance testing and management of refractory relapse cases. The risk of relapse is influenced by: 1) the choice of induction therapy, with higher mortality risk with fluconazole monotherapy which can select for resistance; 2) non-adherence to or lack of secondary prophylaxis; 3) failure of linkage-to-care or retention-in-care of HIV ART programs.

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Section: Introductionmentioning

confidence: 99%

Diagnosis and Management of Cryptococcal Relapse

et al. 2013

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“…In vitro investigations on various strains of C. neoformans indicate that mutation to Flu resistance is a dynamic and heterogeneous process that involves multiple mechanisms [ 13 , 14 ]. Recently, concerns have been raised about the efficacy of initial Flu treatments of cryptococcal meningitis in HIV patients, as resistance to Flu leads to a relapse of cryptococcal meningitis symptoms [ 15 , 16 ]. In such cases, a combination of Amp B and Flu or voriconazole has been suggested [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Prosopilosidine from Prosopis glandulosa var. glandulosa against Cryptococcus neoformans Infection in a Murine Model

et al. 2018

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In this study, 2,3-dihydro-1H-indolizinium alkaloid-prosopilosidine (PPD), that was isolated from Prosopis glandulosa, was evaluated against C. neoformans in a murine model of cryptococcosis. In vitro and in vivo toxicity of indolizidines were also evaluated. Mice were infected via the tail vein with live C. neoformans. Twenty-four hours post-infection, the mice were treated with PPD once a day (i.p.) or twice a day (bid) orally, or with amphotericin B (Amp B) intraperitoneally (IP), or with fluconazole (Flu) orally for 5 days. The brains of all of the animals were aseptically removed and the numbers of live C. neoformans were recovered. In vitro toxicity of indolizidine alkaloids was determined in HepG2 cells. PPD showed to be potent in vivo activity against C. neoformans at a dose of 0.0625 mg/kg by eliminating ~76% of the organisms compared to ~83% with Amp B (1.5 mg/kg). In addition, PPD was found to be equally efficacious, but less toxic, at either 0.125 or 0.0625 mg/kg compared to Amp B (1.5 mg/kg) when it was administered bid (twice a day) by an i.p. route. When tested by an oral route, PPD (10 mg/kg) showed potent activity in this murine model of cryptococcosis with ~82% of organisms eliminated from the brain tissue, whereas Flu (15 mg/kg) reduced ~90% of the infection. In vitro results suggest that quaternary indolizidines were less toxic as compared to those of tertiary bases. PPD (20 mg/kg) did not cause any alteration in the plasma chemistry profiles. These results indicated that PPD was active in eliminating cryptococcal infection by oral and i.p. routes at lower doses compared to Amp B. or Flu.

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Kryptokokkenmeningoenzephalitis bei einem HIV-positiven Patienten mit Rezidiv bei Resistenz gegenüber Fluconazol und IRIS

Cited by 2 publications

References 19 publications

Diagnosis and Management of Cryptococcal Relapse

Diagnosis and Management of Cryptococcal Relapse

Efficacy of Prosopilosidine from Prosopis glandulosa var. glandulosa against Cryptococcus neoformans Infection in a Murine Model

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